It's a bit of a broad/vague question, so let me break it down.
In my institution (and probably most institutions), pretty much every admitted patient gets CBC/lytes/Cr done every morning. The only exceptions I can think of are uncomplicated post-op lap appy/lap chole in a young patient and a young patient coming in with a simple asthma exacerbation requiring inhalers and regular peak-flow checks (gotta get that 80% of predicted!).
However, there are some patients that I think don't require such regular testing. A 90F with multiple cardiovascular risk factors coming in for a CHF exacerbation requiring furosemide would probably need her Cr/lytes regularly monitored, but is a daily CBC (in the absence of any previously-established hematological abnormality) really necessary post-admission? Even with the Cr/lytes, is it absolutely necessary to monitor daily? What about every other day, etc.? Of course, I'm assuming she had her CBC/additional bloodwork on the ER doc's DDx done when she first presented.
Another example is a patient coming in with alcoholic hepatitis and pancytopenia likely secondary to liver cirrhosis. Once we're giving prednisone and the patient's condition (jaundice, symptoms, bilirubin) is improving after the first few days, but they're still not quite ready for discharge, do we really need to trend their blood counts/LFTs daily? We know they have liver cirrhosis from EtOH use; we know they have pancytopenia as a result of EtOH cirrhosis from initial bloodwork done in the ER. Do we really need to check everyday if they're just gradually improving and they're already on the appropriate management for their condition?
I'm just curious because I haven't been able to find too many resources on appropriate bloodwork in the hospital setting (besides common sense, e.g. CHF patient on renally-active diuretics), so I'm just following what most attendings have usually been doing. On IM, I also didn't really get questioned too much by my residents/attendings if I'd order daily CBC/lytes/Cr on the CHF patient, or daily CBC/lytes/Cr/LFTs on the cirrhosis patient. As I'm reflecting on this practice, however, I can't help but think that some of these investigations, while cheap to do, are a bit overkill and I'm poking patients for no reason.
Would any of the bright minds of this subreddit be able to provide additional context?
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